Have more than one health cover? Know how to make a claim on multiple health insurance policies
New Delhi: After the Covid-19 epidemic, the importance of having adequate health insurance coverage for yourself and your family members has increased. The cost of treatment was already rising and hospitalizations from the coronavirus have seen many pay hospital bills in lakhs.
Those who did not have health coverage opted for new plans while those who already had existing coverage purchased new plans or increased coverage through supplement or super supplement plans. Having multiple health insurance policies with the same or different insurer is perfectly acceptable.
Yes, you are allowed to use multiple policies, such as your employer’s group policy, your individual health policy, and your supplemental health policy, for a single claim.
Let’s say you have insurance coverage provided by the office. Let’s say your employer’s health coverage, which promises to reimburse your hospital bills, has an insured sum of Rs 3 lakh. At the same time, you also have your own personal health coverage – again, reimbursement-based – of Rs 3 lakh. Let’s say your hospital bill is Rs 2 lakh. In this case, you can choose either of the two policies for the entire settlement of the claims.
Now if your hospital bill is say Rs 4 lakh, you can claim Rs 3 lakh under your group coverage and the remaining Rs 1 lakh under your own policy.
Also, it should be noted that if your first insurer does not cover a certain type of expense, for example pre-hospitalization tests, then you can claim that particular expense from the other insurer.
“Insureds may have more than one health insurance plan. However, they cannot claim reimbursement for the same expense from more than one insurer. If one coverage is not sufficient, the other coverage can be used to cover expenses. . “
If you have two indemnity policies, you have the right to choose the policy under which you want to make the claim first. If the amount of the loss is greater than the sum insured under the contract on which you made the first loss, you can claim the amount of the balance of the second contract.
“So keep that in mind when filing a claim under two policies. Both insurers (new and existing) had to be made aware of the other policy.” said Goel.
He further added that “in fact, one should be aware that while purchasing health insurance one is required to fill out application forms, in which the insurer requests disclosure of any existing policy. The purpose Main of this claim is that there is a contribution clause in most policies. The contribution clause means that for the same “insured interest” if there is more than one policy, then in the event of a loss , all policies will contribute in a proportion equal to the sum insured. ”
For example, let’s say you have reimbursement coverage of Rs 3 lakh and a fixed benefit policy of Rs 3 lakh. You undergo surgery, which costs you Rs 3 lakh. Now you can claim Rs 3 lakh from your refund policy so that its processing fee is covered.
You can also claim this amount under the fixed benefit policy. It will be useful for managing post-surgical recovery expenses, loss of income, etc. The claims process in the case of fixed benefit policies is relatively simpler: all you need to do is provide photocopies of the treatment bills as proof of contracting the illness and the sum insured will be paid to you.